The most common cancer of endocrine (gland) origin is thyroid cancer. It is 2.1 percent of all cancers. TCs are evaluated in three main groups.
Well Differentiated Thyroid Cancers (WTCs): The most common WTCs with a rate of 95 percent; It is divided into three subgroups: papillary (PTC), follicular (FTC) and Hurthle cell (HTC). The 20-year mortality rate is between 1-7 percent. Recurrences (often in lymph nodes) and distant metastases may develop in 20 percent. The typical presentation is a painless thyroid nodule. Worrying findings; hoarseness, difficulty swallowing, whistling, and rarely neck pain. Ultrasonography (US) identifies high-risk features for cancer. 'Thyroid Fine Needle Aspiration Biopsy' (TINAB) is recommended in such patients.
The treatment of TINABs is primarily the complete removal of thyroid tissue, called 'Total Thyroidectomy' (TT). In some cases, neck lymph node removal may also be necessary. Since IDTKs are sensitive to radioactive iodine (RAI), both RAI scanning and, if necessary, RAI ablation (destruction) become easier after TT surgery. In addition, TT allows monitoring with 'Thyroglobulin' (Tg), which has diagnostic value for TC recurrence. RAI (atom) treatment is applied to monitor with Tg in the post-TT period and to reduce the risk of recurrence. It is essential to use medication to keep TSH, which has a stimulating effect on the growth of thyroid cancer cells, at certain low levels depending on the risk. Tg and neck US should be monitored more frequently in the first 5 years and then at 6-12 month intervals. Patients need to be kept under lifelong observation as it may recur many years after surgery.
Medullary Thyroid Cancer (MTK): It accounts for 7 percent of all TCs and 14 percent of deaths due to TCs. It creates . Its treatment and follow-up are different from DTCs; RAI and TSH suppression treatments are ineffective. In MTC with aggressive behavior, 10-year survival is 75 percent. There are two different types of MTCs: coincidental and hereditary (25 percent).
The reason for presentation of coincidental MTCs is similar to NTCs, but since it is more aggressive, it is often an advanced disease. presents with the disease. During diagnosis, some There is play lymph node and distant organ splash. In hereditary MTCs, there are also symptoms of certain accompanying diseases. Incidental MTC is diagnosed by FNAB. Before surgery for patients at risk of MTC; Calcitonin and CEA measurement, as well as an effective Neck US, should be performed.
Surgical treatment in patients with MTC is more extensive than in ITCK. All patients over the age of 6 diagnosed with MTC should undergo bilateral removal of the anterior neck lymph nodes in addition to TT. If lymph node spread is detected before the surgery or if the calcitonin level continues to be high after the first surgery, the lymph nodes on the side of the neck must be removed. They should be closely monitored since the risk of progression and recurrence of the disease is high. Increase in calcitonin and CEA requires an effective neck US in terms of recurrence.
Anaplastic Thyroid Cancer (ATK): It constitutes only 1-2 percent of TCs. It is the most lethal TK. Unlike other TKs, ATK appears and progresses quickly. Being aggressive and tending to jump early and frequently makes ATK almost always fatal, and most of them disappear within 6 months. Although ATK starts as direct ATK, it more often originates from a previously existing PTK or FTK.
Surgery complications such as hoarseness and low calcium are minimized when performed by an experienced team. . Stay cheerful and well-being.
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